Sunday, March 30, 2014

Notes on Cooper's Vet Visit for Moderator Band Cardiomyopathy

Here are the notes from Friday's cardiology echo:

Note-he has a thickened left vent wall asymmetrically thickened.

"Cooper's recurrent respiratory symptoms are due to a relapse of congestive heart failure. This rapid recurrence of heart failure is particularly concerning given the fact that Cooper has been receiving doses of cardiac medications that are typically very effective in initial management of the condition.  This raises concerns that Cooper's heart disease is more aggressive than the average patient.  A repeat echocardiogram was performed and the images were clearer because Cooper's heart rate was not as rapid as during his initial echocardiogram last week.  The echocardiogram revealed numerous moderator bands in his left ventricle and mild weakening of cardiac muscle strength (contraction).  The area that I was previously concerned may be a clot within the left ventricle is actually a network of moderator bands.  These echocardiographic findings are more typical of moderator band cardiomyopathy rather than hypertrophic cardiomyopathy.  Moderator band cardiomyopathy is a rare condition and there is little information regarding its natural history.  There is no known cause of the condition.   Cooper was hospitalized and was treated with oxygen therapy, lasix injections and oral medications (spironolacone, vetmedin, and plavix) to manage his heart disease and stabilize his heart failure.  Repeat radiographs this morning revealed almost complete improvement of the congestion in his lungs.  I expect his congestion to fully resolve after the last injection of lasix that he received today at noon.  He has proven that he requires higher than typical doses of diuretic to manage his heart failure.  This comes with a risk of dehydration and adverse effects on the kidneys.  Considering he has such a rare cardiac condition that has already proven to be somewhat resistant to traditional pharmacologic therapy, I feel that Cooper is a prime candidate for consultation on alternative treatments
. (Holistic-there is a local vet she recommended.)

Saturday, March 29, 2014

Cooper Quickly Develops Moderator Band Cardiomyopathy After Seven Years and Two Echos That Did Not Show Heart Disease in 2012

We found out a week ago Friday that Cooper, our very large part Maine Coon cat, which is seven years old, has heart disease.  He has not been himself since the February dental surgery he had at MSU.  He's lost over a pound since December; his calcium level is up (a history of hypercalcemia) a bit as of the January blood work (we've been fighting hypercalcemia for two years and had it just below high normal a year ago but now it's above normal.)  He has not been eating well since the dental surgery.  While he began to eat more, he soon slowed down.  A trick to get him to eat more that worked one day, wouldn't work the next; the food he loved one day, he wouldn't eat later in the day.   I bought kitten dry food on Thursday because it has more calories and more protein.  He ate some Friday morning but not enough.  So, I called the vet and made an appointment for later in the afternoon.

The vet discovered he had congestion and a large heart.  We've been through all of this with Myrna our HCM (hypertrophic cardiomyopathy) cat but it didn't prevent the news from being upsetting.  I called Myrna's cardiologist to see if she was still in the office although by then they were closed.  She wasn't but she said she would come in and do an echo to check the heart. (We are so grateful for her. She's been wonderful with Myrna.)  I drove Cooper up to Novi ER where they stabilized him, gave him lasix, and put him on oxygen.  Then the cardio did the echo.  At first she thought he had HCM but the lungs were so full of fluid that it was difficult to get a good reading.

His heart seemed segmented in one area by lumps of thickened wall.  Cooper is seven years old, sort of young but in the age range that most cardiac issues are discovered in cats. It could be that it was developing over the summer which is why Cooper began to lose weight.  It is likely that the stress of the dental surgery as well as the anesthesia was a trigger for further development of the heart disease and CHF.  

We brought him home last Saturday after a night in the ER.  He was put on lasix 10mg twice a day to get rid of extra fluid to prevent CHF.   He began Plavix and Spironolactone as well.  

His heart disease developed quickly.  He had an echo two years ago when he first had hypercalcemia and we were worried about the effects on the heart.   The echo was clear. He had a stress related murmur that he's had even as a kitten but no sign of disease. Last summer he weighed 12.8 lbs and began to slowly lose weight-an ounce here, 1/2 ounce there but he was eating well enough. By December he wasn't always eating everything offered and by the end of December he weighed 12.1 lbs. We knew that he hadn't been eating well but thought it had to do with the tooth he was losing to resorption. Two months later at the dental surgery, he weighed 11.5. We had not realized that he had drastically lost weight. We now believe the weight loss indicated the onset of heart disease. At no time did he ever present with congestion until last week. It wasn't until he really didn't want to eat last week, and that he looked tired, and that on Thursday seemed to breathe fast, that I knew he needed to see the vet. But even then, I wasn't expecting heart disease. I thought the hypercalcemia was causing issues again.

After last week's ER visit, he perked up and began eating more and seemed more alert. His breathing improved and was stable at 8-10 in 15 seconds.  But by Tuesday, it was about 14 in 15 seconds so around 60 per minute. If this were Myrna, that would be WAY too high. But he was up and about and the breathing wasn't labored and it went down to 12 and up to 14 when he was moving about.  But by 1 a.m. he exhibited such labored effort to breathe that I gave him 10mg more of lasix.  The rate fell to 15 and wasn't as labored.  Eventually, we fell asleep and I went back to bed. 

Thursday he wasn't better and hadn't urinated.  So, I had my husband come home and take him to the vet ER/cardiologist office.  I had an appointment for later that day with Myrna to see the cardiologist.   In short, they placed him in the ER all Thursday through Friday.  They gave him IV lasix, and later lasix injections.  He was placed on oxygen until Friday a.m. when his xrays were more clear.  Friday, the cardiologist did an echo and found that he has Moderator Band Cardiomyopathy and not HCM she had originally suspected.  He came home Friday afternoon.

His kidneys are fine; he was actually dehydrated so while the lasix kicked out some fluid slowly, it wasn't forcing out the fluid from the lungs as quickly as it was fluid from any other part of the body.  Eventually, the lasix worked. 

Cooper is receiving lasix 10mg three times a day (TID); spironolactone 1/4 twice a day; 1.25 mg of Vetmedin twice a day (the medication isn't for HCM so Myrna our HCM cat is not taking it.)  Valium for litter box use he was already receiving; and 1/4 tab of Plavix once a day.  So far, no beta blockers or ACE inhibitors.   Moderator Band Cardiomyopathy (MBCM) has bands of muscle tissue that are restricting the heart valve from properly contracting.  The bands connect across from wall to wall in the valve; can link or weave together.  They do not belong there.  There is no known surgery to remove them.  No medication that can decrease them.  The symptoms must be fought with meds and treated as if the patient has heart disease such as HCM.  We must be aggressive with his congestion to prevent CHF-congestive heart failure-and will give extra lasix as needed.  He doesn't need to be seen until May if all goes well. 

I need to do a lot of research to learn more about this disease.  But in general, scientific research assumed that cats were born with MBCM because most cats don't have heart echos before getting heart disease.  In his case, he had and he was clear of disease.  So, he somehow developed heart disease-without any indications two years ago, and without any known contributing factors.  But the symptoms are the same as with HCM; the meds are used for the same reasons.  We've been through all of this with one of our other cats that has HCM.   

What is different is that between Cooper and Myrna our HCM cat, the reaction to the effects are different and their symptoms are different.  Myrna bounced back as a kitten once she recovered from CHF but not Cooper.  Myrna breathes gradually faster and it becomes more labored and she looks miserable if CHF comes on before we can conquer it with more lasix. But not Cooper. He kept breathing fast and then slowing down.  He still ate. He moved about.  He didn't seem in pain or miserable until we went to bed.  Then his breathing was suddenly very labored even if it was as fast as it had been early that evening.  Myrna reacts quickly to lasix but not Cooper.  

Cooper Returned Home Friday

Cooper came home this afternoon. They had him on oxygen until this morning because his breathing was so fast. But it turned out that his lungs were finally clear after a night of lasix. He was breathing fast due to anxiety which they didn't realize until the am X-rays . He's now on pimobedan or vetmedin as well as the rest. He looks much better today after a day in the Er than he did last week. He was even relaxed and stretched out in the crate in the car. He breathes fast apparently so we need to learn what is normal and what indicates he needs lasix. I'm starting a Facebook and blog for mbcm. I'll let you know more when they're up and established.

Cooper Returns to ER with CHF Almost a Week After Leaving Hospital-Turns Out He Has Rare Disease

Myrna and Cooper were to see cardiologist today-a recheck for Cooper after being in the hospital last Friday night for CHF; and a regular checkup for Myrna.   He had slowly bounced back from being in the ER with CHF last Friday.  He came home Saturday looking miserable and slept in the basement.  But Sunday he was more alert and more social, choosing to sleep in our bed.  He continued to be more social, eat more and more often, and take his heart meds as the week went along.  However, his breathing rate ran 10-14 and continued to be around 12-14 by Wednesday night.  By 1 a.m. the breathing rate was 20 in 15 seconds.  He was breathing very fast but not panting, not looking uncomfortable.  I gave him 10mg lasix. By 1:25 a.m. the rate came down to 15 where it remained until morning.  We decided he wasn't getting better because despite 10mg at 1 a.m. and 10mg at 7:30 a.m., he had only urinated once.  So my husband took him to the cardio's office, which is connected to the ER. They put him on oxygen.  When I took Myrna in for the 3 p.m. appointment, I discussed Cooper with the cardiologist.  He unfortunately, has CHF again and will remain overnight in the ER on oxygen and IV lasix.  

Dr. DeSana did a new echo today.  As reported Friday, he has cardiomyopathy but today she was better able to see the heart.  He does NOT have HCM.  He has a rare disease called
 Moderator Band Cardiomyopathy.  There is NO clot nor thickened section of a valve wall. What he has are bands of muscle tissue that connect themselves to sections in a chamber of the heart.  They don't belong there.  They are restricting blood flow and ability of the valve to work. The connective bands make it look as if the chamber is segmented when it's not.  I need to research this more.  But here are some links:

He's not in danger of having heart failure any time soon. He has NO clot which is great news. He is at risk-as are all cardio patients-of getting clots, arrhythmias, low or high blood pressure, and congestion, which he is battling now. 

She said his lungs are worse with congestion than Myrna's have ever been.  And she fainted and had trouble breathing, and was in pain and lethargic when she had CHF. Cooper has not fainted, grown weak or lethargic, or looked in great pain and discomfort. We don't know why he has congestion.  It could be that his lungs were not that clear when they released him Saturday. They listened to his lungs but did not take new films. LESSON LEARNED:  if fighting congestion, always get new xrays taken when you think the lungs sound clear to make sure they are clear. 

The problem is that he's not responding well to lasix.  His kidneys are perfect. The blood values are fine; he concentrates urine; his specific gravity is normal.  And strangely enough, he's actually dehydrated!  The only fluid in his body is in his lungs.  But for some reason, the lasix isn't causing the body to send fluid to the kidneys to be excreted as quickly as it should, certainly not as quickly as it works for Myrna.  The vet will now be more aggressive.  He will receive IV lasix tonight in the ER.  

His breathing rate at noon was 72; by 4 p.m. it was down to 42-better.  He was able to come out of oxygen to get an echo without collapsing or without an increase in breathing rate which is good news.

At home, we will use higher doses or dose more often of lasix.  We may need to do injections, supplies we still have for Myrna.  

His condition is very odd.  It's also very rare. It's the first case the cardio has ever seen.  She read about it in vet school but has not treated a case. The cause is unknown.  The research mostly believes that the condition is congenital (unless there's new research) because most cases have occurred in cats that had not had heart echos when the hearts were healthy, prior to being diagnosed. So, researchers assumed the condition was always present when it might not have been.  When he ever does pass away (and he's not expected to any time soon) we will donate his heart to research and the vet may write a paper on it.  

Since the condition is rare, treatment with medications and effects or symptoms of the disease are not well known.   Lasix is needed for sure.  For him, right now, an ACE inhibitor or a beta blocker are not recommended because his heart rate is high, blood pressure is low, and contractility is weak.   She does want to put him on Vetmedin a.k.a. Pimobedan to improve heart contractility.  

She also suggested seeing a holistic vet.  He apparently is very good with difficult cases. I'll look into it.

Cooper will hopefully come home in the morning.  She will call after 9 a.m.  By the way, Cooper looks pissed off in the cage today.  And he hisses whenever the vets or techs open the cage for anything.  He only hisses at home at the other cats, never at us or visitors. (But
 he always hides from visitors.)